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Biologic DMARDs

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By Editorial Team

3 min read

Reviewed by: HU Medical Review Board | Last reviewed: August 2024 | Last updated: August 2024

Disease-modifying antirheumatic drugs (DMARDs) have greatly improved treatment for rheumatoid arthritis (RA). People with RA now have more and better treatment options. DMARDs can change the course of the disease. They can slow or prevent damage to joints and related structures.1,2

There are 3 types of DMARDs: conventional, biologic, and targeted synthetic. Biologic DMARDs are proteins made in a lab to target specific substances in the body. They block certain immune processes to reduce inflammation. Biologic DMARDs can increase your risk of infections and other side effects. Talk to your doctor about whether biologic DMARDs are right for you.1,3

How do biologic DMARDs work?

Biologic DMARDs are proteins made from living cells. They are designed to target specific molecules on immune cells. This is different from conventional DMARDs, which act on the whole immune system.2

In RA, certain immune cells are too active. They release chemicals called cytokines. The cytokines activate other immune cells. This leads to ongoing (chronic) inflammation and joint damage. Biologic DMARDs work in different ways to block this process. Biologic DMARDs that treat RA work by:1,2

  • Blocking the activity of cytokines, such as tumor necrosis factor (TNF), interleukin-6 (IL-6), and interleukin-1 (IL-1)
  • Blocking the activation of T cells
  • Depleting other immune cells called B cells

Clinical trials have shown that biologic DMARDs reduce inflammation. They can slow or prevent disease progression. Biologic DMARDs may be used if methotrexate or other conventional DMARDs fail. They seem to be most effective when used in combination with methotrexate.1-3

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TNF inhibitors are the most common biologics for RA. One biologic may work well for some people but not others. A biologic may work at first but then stop working. This is because many body processes are involved in RA inflammation.2

Examples

Several TNF inhibitors are available to treat RA, including:1,2

Other biologic DMARDs are also available to treat RA, including:1,2

Several biosimilars are also available. These drugs are nearly identical to biologics that are already approved. Biosimilars available to treat RA include:1,2

  • Amjevita® (adalimumab), a Humira biosimilar
  • Avsola®, Inflectra®, and Renflexis® (infliximab), Remicade biosimilars
  • Riabni®, Ruxience®, and Truxima® (rituximab), Rituxan biosimilars

What are the possible side effects?

Side effects can vary depending on the specific drug you are taking. Common side effects of biologic DMARDs include:2

  • Infusion or injection site reactions
  • Upper respiratory infections
  • Headaches
  • Rash
  • Autoimmune conditions
  • Nausea, vomiting, and diarrhea

Many biologic DMARDs have a boxed warning. This is the strictest warning from the US Food and Drug Administration (FDA). They have this warning because of rare instances of:4-6

  • Serious infections, especially tuberculosis and fungal infections
  • Certain cancers, especially skin cancer and lymphoma

These are not all the possible side effects of biologic DMARDs. Talk to your doctor about what to expect when taking biologic DMARDs. You also should call your doctor if you have any changes that concern you when taking biologic DMARDs.

Other things to know

Take biologic DMARDs as your doctor prescribes. Most biologics must be taken by injection or infusion into the vein every few weeks. Some biologics are available for injection through the skin at home.1

Many people with RA do not need biologic DMARDs. Experts usually recommend conventional DMARDs (such as methotrexate) as the first choice. If methotrexate is not effective, your doctor may switch you to a biologic DMARD. TNF inhibitors are usually the first biologic DMARDs used to treat RA.2,3

Biologic DMARDs tend to start working within 4 to 8 weeks. The exact time depends on the specific drug. If the first biologic you try does not work or stops working, your doctor can suggest a different biologic. If biologics do not work at all, your doctor may suggest targeted synthetic DMARDs.2,3

Before beginning treatment for RA, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs. Biologic DMARDs can worsen certain other conditions.2